Is There a Difference in Serum Vitamin D Levels and Bone Mineral Density According to Body Mass Index in Young Adult Women?

BACKGROUND: In the life cycle, bone mineral density (BMD) is the most optimal condition in the 20s. In Korea, vitamin D deficiency status is very serious in Korean women due to recent lack of activity, weight polarization, and inadequate nutritional intake. The purpose of this study was to compare serum vitamin D and BMD according to obesity status in Korean young adult women. METHODS: A total of 143 female college students participated in the research. Body fat and lean body status were analyzed using a body composition analyzer. Nutrient intakes of the subjects were assessed by 3-days food record method. The BMDs was measured by dual energy X-ray absorptiometry. The subjects were divided into normal weight group and obesity group on their body mass index. RESULTS: Obesity group showed significantly higher weight, body fat (%), and body fat (kg) than normal weight group and T-scores of lumbar-2 spines were significantly lower. Obesity group showed high triglyceride and low-density lipoprotein cholesterol levels and vitamin D levels were significantly lower. Physical fitness and activity status showed that sit and reach and sit up were significantly lower in obesity group. The intake of carbohydrates was higher in the obesity group than in the normal weight group, and the intake of vitamin C and vitamin D was significantly lower. Factors affecting serum vitamin D were analyzed as body fat (%), lumbar-2 T-score, triglyceride, and carbohydrate intake. CONCLUSIONS: Obese women need more effort to manage their serum vitamin D status and balanced nutrition to prevent bone loss.

Corrigendum: A Comparative study on communicatioin competence, nursing professionalism, work environment and job satisfaction between outpatient nurses and ward nurses / 의료커뮤니케이션

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Concurrent Medullary Thyroid Carcinoma and Primary Thyroid Lymphoma (Diffuse Large B Cell Lymphoma): the First Case Report

Cases of simultaneously occurring medullary thyroid carcinoma (MTC) and lymphoma are extremely rare. An 84-year-old woman visited the hospital due to dyspnea, resulting from rapidly aggravated enlarged neck mass. Ultrasonography revealed two lesions in the thyroid and they were diagnosed as concurrent medullary thyroid carcinoma and diffuse large B cell lymphoma after total thyroidectomy. A few cases simultaneously diagnosed with MTC and systemic lymphoma have been reported. However, the coexistence of MTC and primary thyroid lymphoma is extremely rare.

Differential Diagnosis of Thyroid Follicular Neoplasm from Nodular Hyperplasia by Shear Wave Elastography

OBJECTIVE: More than 50% of diagnostic surgery in cytologically indeterminate thyroid nodules revealed benign nodules of which nodular hyperplasia (NH) accounted for about half. Preoperative exclusion of NH may decrease diagnostic surgery. We aimed to study the diagnostic performance of shear wave elastography (SWE) to differentiate follicular neoplasm (FN) from NH in follicular lesions of thyroid nodules. METHODS: We analyzed the data from 61 patients who underwent SWE before ultrasound-guided core-needle biopsy (CNB) from August 2016 to May 2018 and CNB results were FN (n=19) and NH (n=42). We analyzed the magnitude of elasticity index (EI) and patterns of high EI area (EI >36 kPa). The patterns of high EI area was classified as marginal pattern (high EI areas are restricted in the outer 1/3 of the nodule) and traversing pattern (high EI areas approaching further to the center of the nodule within inner 2/3 of the nodule). RESULTS: The E(Max), E(Mean), E(SD), and percent of high EI area were significantly lower in FN than NH (P<0.001). The diagnostic performance to predict FN showed sensitivity, specificity, and accuracy of 95%, 90%, and 92% by E(Max) <42.1 kPa, and of 95%, 79%, and 84% by E(Mean) <23.5 kPa, and of 89%, 93%, and 92% by marginal pattern of high EI area, respectively. CONCLUSION: Novel diagnostic criteria of E(Max) less than 42.1 kPa and marginal pattern of high EI area on SWE can predict FN with high diagnostic accuracy, waiving diagnostic surgery of NH in indeterminate cytology.

Utility of shear wave elastography to detect papillary thyroid carcinoma in thyroid nodules: efficacy of the standard deviation elasticity

BACKGROUND/AIMS@#The aim of this study was to address the role of the elasticity index as a possible predictive marker for detecting papillary thyroid carcinoma (PTC) and quantitatively assess shear wave elastography (SWE) as a tool for differentiating PTC from benign thyroid nodules.@*METHODS@#One hundred and nineteen patients with thyroid nodules undergoing SWE before ultrasound-guided fine needle aspiration and core needle biopsy were analyzed. The mean (E(Mean)), minimum (E(Min)), maximum (E(Max)), and standard deviation (E(SD)) of SWE elasticity indices were measured.@*RESULTS@#Among 105 nodules, 14 were PTC and 91 were benign. The E(Mean), E(Min), and E(Max) values were significantly higher in PTCs than benign nodules (E(Mean) 37.4 in PTC vs. 23.7 in benign nodules, p = 0.005; E(Min) 27.9 vs. 17.8, p = 0.034; E(Max) 46.7 vs. 31.5, p < 0.001). The E(Mean), E(Min), and E(Max) were significantly associated with PTC with diagnostic odds ratios varying from 6.74 to 9.91, high specificities (86.4%, 86.4%, and 88.1%, respectively), and positive likelihood ratios (4.21, 3.69, and 4.82, respectively). The E(SD) values were significantly higher in PTC than in benign nodules (6.3 vs. 2.6, p < 0.001). E(SD) had the highest specificity (96.6%) when applied with a cut-off value of 6.5 kPa. It had a positive likelihood ratio of 14.75 and a diagnostic odds ratio of 28.50.@*CONCLUSIONS@#The shear elasticity index of E(SD), with higher likelihood ratios for PTC, will probably identify nodules that have a high potential for malignancy. It may help to identify and select malignant nodules, while reducing unnecessary fine needle aspiration and core needle biopsies of benign nodules.

Association between Sarcopenia, Sarcopenic Obesity, and Chronic Disease in Korean Elderly

BACKGROUND: It is a very important social issue for Korea to have a healthy old age as an aged society. Aging causes a lot of physical changes, especially sarcopenia. Sarcopenia is defined as a persistent decrease in skeletal muscle and muscle strength. Sarcopenic obesity is a phenomenon in which fat is replaced instead of muscle. The purpose of this study was to examine the prevalence of sarcopenia and sarcopenic obesity in Korean elderly and to analyze the relationship with chronic disease. METHODS: Data from the 2008 to 2011 the Korea National Health and Nutrition Survey were used. A total of 3,492 patients were classified into 3 groups (non-sarcopenia, sarcopenia, sarcopenic obesity), and general, anthropometry, health behavior, nutrient intake and chronic disease status were compared by the statistical analysis. RESULTS: The rate of moderate exercise was significantly lower in the sarcopenia and sarcopenic-obesity group than in the non-sarcopenia group (P=0.007). The sarcopenic obesity group had significantly higher energy (P=0.005), protein (P=0.046) and fat (P=0.001) intake than the sarcopenic group. The sarcopenic-obesity group had the highest ratio of diabetes (P=0.023) and dyslipidemia (P=0.004) in the 3 groups. Compared with the non-sarcopenia group, in the sarcopenia and sarcopenic obesity groups, the odds ratios (ORs) of diabetes was increased by 1.24 and 2.16 while the ORs of dyslipidemia was increased by 1.12 and 1.50, respectively. CONCLUSIONS: Regular exercise and adequate nutrient intake (energy, protein and fat) are essential for the prevention of sarcopenia in Korean elderly, and management of chronic disease in sarcopenic obesity elderly is important.

Association between Serum Cystatin C and Vascular Complications in Type 2 Diabetes Mellitus without Nephropathy

BACKGROUND: Recent studies have correlated serum cystatin C (CysC) with vascular complications, but few studies have investigated this correlation in diabetes patients without nephropathy. This study aimed to evaluate if higher serum CysC levels increase the risk for vascular complications in type 2 diabetes mellitus patients with normal renal function or mild renal impairment. METHODS: A total of 806 consecutive patients with type 2 diabetes mellitus who were admitted to the diabetes center of Soonchunhyang University Hospital for blood glucose control were retrospectively reviewed. Patients with nephropathy were excluded. Subjects were categorized into quartiles of serum CysC levels (Q1, ≤0.65 mg/L; Q2, 0.66 to 0.79 mg/L; Q3, 0.80 to 0.94 mg/L; and Q4, ≥0.95 mg/L). RESULTS: The proportion of patients with diabetic retinopathy (DR) (P for trend < 0.001), coronary heart disease (CHD) (P for trend < 0.001), and stroke (P for trend < 0.001) increased across the serum CysC quartiles. After adjustment for confounding factors, the highest serum CysC level remained a significant risk factor for DR (odds ratio [OR], 1.929; 95% confidence interval [CI], 1.007 to 4.144; P=0.040). Compared with Q1, a significant positive association was observed between serum CysC and CHD in Q2 (OR, 7.321; 95% CI, 1.114 to 48.114; P=0.012), Q3 (OR, 6.027; 95% CI, 0.952 to 38.161; P=0.020), and Q4 (OR, 8.122; 95% CI, 1.258 to 52.453; P=0.007). No associations were observed between CysC and stroke after additional adjustment for confounding variables. CONCLUSION: Serum CysC levels are independently associated with DR and CHD, suggesting that CysC may be useful for identifying type 2 diabetes mellitus patients without nephropathy who are at high risk for vascular complications.

Pediatric Deaths and Venipuncture / 대한법의학회지

Venipuncture is a routine and relatively safe and painless medical procedure, necessary for accurate diagnosis and treatment. However, given that pain related to medical procedures may have adverse effects for children, could venipuncture cause deaths in infants and children? We analyzed our cases of unexpected death after venipuncture and conducted a literature review on them. A vasovagal response to noxious stimuli may explain such a sudden death immediately after venipuncture, commonly presented as needle phobia, breath-holding spell, and reflex anoxic seizure in the literature, despite the fact that the current medical evidence is not enough to prove their casual relationship. In addition, pain prevention and management during medical procedure is incorporated in clinical guidelines for pediatric patients, because painful medical procedures negatively affect child development. Thus, prevention and management of pain related to medical procedure may be helpful to avoid an adverse vasovagal response to noxious stimuli from occurring.

A Comparative Study on Communicatioin Competence, Nursing Professionalism, Work Environment and Job Satisfaction between Outpatient Nurses and Ward Nurses / 의료커뮤니케이션

PURPOSE: The purpose of this study was to compare communication competence, nursing professionalism, work environment and job satisfaction between outpatient nurses and ward nurses, and to identify the correlation among variables.METHODS: The participants were 90 outpatient nurses and 98 ward nurses at the two general hospitals. Data were collected using self-administered questionnaires. Data were analyzed using descriptive statistics, χ2-test, independent t-test and Pearson's correlation coefficient.RESULTS: There were statistically significant differences between two groups in nursing professionalism, possibilities for development, commitment to the workplace, social support from colleagues, social community at work and job satisfaction, outpatient nurses showed higher level than ward nurses except commitment to the workplace. The work environment variables and nurses' job satisfaction were mostly correlated. Job satisfaction showed significant negatively correlated with quantitative demands, emotional demands and role conflicts in both groups nurses.CONCLUSION: These findings showed that nursing work environments were the most important factor for job satisfaction of both group nurses. Therefore, it is necessary to put efforts in improving nursing work environment and to develop diverse strategies for human resource management.

Reference intervals of thyroid hormones during pregnancy in Korea, an iodine-replete area

BACKGROUND/AIMS: Maternal thyroid dysfunction has been associated with adverse pregnancy outcomes. The purpose of our study was to establish trimester-specific reference intervals for thyroid hormones in pregnant women in Korea, where iodine intake is more than adequate and to examine pregnancy and perinatal outcomes in their offspring. METHODS: Among 459 healthy pregnant women who were screened, we enrolled 417 subjects who had negative results for thyroid autoantibodies. Serum thyroid stimulating hormone (TSH) and free thyroxine were measured using an immunoradiometric assay. Urine iodine concentration was measured using inductively coupled plasma-mass spectrometry in 275 women. Reference ranges of thyroid hormones were determined according to the guidelines of the National Academy of Clinical Biochemistry. Pregnancy and perinatal outcomes were compared according to maternal thyroid function. RESULTS: The reference ranges of serum TSH were 0.03 to 4.24 mIU/L in the first trimester, 0.13 to 4.84 mIU/L in the second trimester, and 0.30 to 5.57 mIU/L in the third trimester. Pregnancy and perinatal outcomes did not vary in mothers with subtle changes in thyroid function. CONCLUSIONS: Trimester-specific thyroid hormone reference intervals in Korean pregnant women differ from those of other countries with different iodine nutrition status and ethnicity. The establishment of population-based, reliable trimester-specific reference intervals is critical for the interpretation of thyroid function in pregnant women to avoid unnecessary tests and treatments.

Pediatric Deaths and Venipuncture / 대한법의학회지

Venipuncture is a routine and relatively safe and painless medical procedure, necessary for accurate diagnosis and treatment. However, given that pain related to medical procedures may have adverse effects for children, could venipuncture cause deaths in infants and children? We analyzed our cases of unexpected death after venipuncture and conducted a literature review on them. A vasovagal response to noxious stimuli may explain such a sudden death immediately after venipuncture, commonly presented as needle phobia, breath-holding spell, and reflex anoxic seizure in the literature, despite the fact that the current medical evidence is not enough to prove their casual relationship. In addition, pain prevention and management during medical procedure is incorporated in clinical guidelines for pediatric patients, because painful medical procedures negatively affect child development. Thus, prevention and management of pain related to medical procedure may be helpful to avoid an adverse vasovagal response to noxious stimuli from occurring.

MRI Findings of Intercostal Schwannoma: A Case Report

Intercostal schwannomas are uncommon, encapsulated neoplasms that originate in nerve sheaths of intercostal nerves. They account for less than 10% of primary neural tumors of the chest wall. Herein, we report a pathologically confirmed case of intercostal schwannoma with typical magnetic resonance imaging findings.

Adenosquamous Carcinoma of Duodenal Bulb Mimicking Subepithelial Tumor on Computed Tomography: A Case Report

Adenosquamous carcinomas of the duodenum are extremely rare neoplasms in which both glandular and squamous elements demonstrate malignant characteristics. Few cases of adenosquamous carcinoma involving the second or third segment of the duodenum have been reported in the literature. Herein, we report the first case of adenosquamous carcinoma of the bulb of the duodenum that mimicked subepithelial tumor on computed tomography in a 59-year-old man.

Fatal Delayed Hemothorax after Simple Rib Fracture / 대한법의학회지

We report the case of a 66-year-old man who died of fatal delayed hemothorax after blunt trauma to the chest. When the deceased was transferred to the hospital, his vital signs were stable; hence, medical attention was focused only on the fracture on right ankle. Three days after the orthopedic surgery, he became unsettled with symptoms similar to delirium and exhibited unstable vital signs; he then suddenly died. On autopsy, a beveled fracture was identified on the posterior aspect of the left second rib with hemothorax. It was because of a rupture in the intercostal artery at the fracture site that a simple fracture in a rib, following a blunt chest trauma can be a potentially life-threatening condition. We suggest that a meticulous examination should be performed at the rib fracture sites when a blunt trauma to the chest is suspected even when there are no internal organ injuries identified except hemothorax.

Linking resistin, inflammation, and cardiometabolic diseases

Adipose tissue secretes a variety of bioactive substances that are associated with chronic inflammation, insulin resistance, and an increased risk of type 2 diabetes mellitus. While resistin was first known as an adipocyte-secreted hormone (adipokine) linked to obesity and insulin resistance in rodents, it is predominantly expressed and secreted by macrophages in humans. Epidemiological and genetic studies indicate that increased resistin levels are associated with the development of insulin resistance, diabetes, and cardiovascular disease. Resistin also appears to mediate the pathogenesis of atherosclerosis by promoting endothelial dysfunction, vascular smooth muscle cell proliferation, arterial inflammation, and the formation of foam cells. Thus, resistin is predictive of atherosclerosis and poor clinical outcomes in patients with cardiovascular disease and heart failure. Furthermore, recent evidence suggests that resistin is associated with atherogenic dyslipidemia and hypertension. The present review will focus on the role of human resistin in the pathogeneses of inflammation and obesity-related diseases.

Posterior Reversible Encephalopathy Syndrome Accompanied by a Cerebral Hemorrhage and Restricted Diffusion in a Child with Uncontrolled Nephrotic Syndrome / 대한소아신경학회지

Posterior reversible encephalopathy syndrome (PRES) is a rare clinico-radiological syndrome that is characterized by an acute onset of headache, vomiting, visual abnormalities, confusion, and/or seizures and is typically accompanied with edema of predominantly posterior portions of the cerebral hemispheres. Here, we report a case of PRES with cerebral hemorrhage that occurred in a female pediatric patient with uncontrolled nephrotic syndrome. The patient's magnetic resonance imaging (MRI) studies showed asymmetric white matter abnormalities, cerebral hemorrhage, and restricted diffusion. After controlling her hypertension and nephrotic syndrome, her neurologic symptoms improved, and follow-up MRI findings revealed interval resolving of the white matter lesions.

Death Related to Nitrous Oxide Abuse: Two Cases Report / 대한법의학회지

Nitrous oxide is medically used as an anesthetic gas and as an additive in whipped cream production. Few cases of death from nitrous oxide intoxication have been reported in Korea. However, fatalities due to inhalation of pure nitrous oxide in an amount enough to cause death have been recently increasing. We report two cases of death related to nitrous oxide abuse with a review of literature focusing on the fact that nitrous oxide abuse can be considered as a possible cause of death if appliances with nitrous oxide contents were found during the investigation, and the autopsy and toxicological findings cannot be attributed to nitrous oxide intoxication.

Assessment of Blood-Brain Barrier Permeability by Dynamic Contrast-Enhanced MRI in Transient Middle Cerebral Artery Occlusion Model after Localized Brain Cooling in Rats

OBJECTIVE: The purpose of this study was to evaluate the effects of localized brain cooling on blood-brain barrier (BBB) permeability following transient middle cerebral artery occlusion (tMCAO) in rats, by using dynamic contrast-enhanced (DCE)-MRI. MATERIALS AND METHODS: Thirty rats were divided into 3 groups of 10 rats each: control group, localized cold-saline (20℃) infusion group, and localized warm-saline (37℃) infusion group. The left middle cerebral artery (MCA) was occluded for 1 hour in anesthetized rats, followed by 3 hours of reperfusion. In the localized saline infusion group, 6 mL of cold or warm saline was infused through the hollow filament for 10 minutes after MCA occlusion. DCE-MRI investigations were performed after 3 hours and 24 hours of reperfusion. Pharmacokinetic parameters of the extended Tofts-Kety model were calculated for each DCE-MRI. In addition, rotarod testing was performed before tMCAO, and on days 1-9 after tMCAO. Myeloperoxidase (MPO) immunohisto-chemistry was performed to identify infiltrating neutrophils associated with the inflammatory response in the rat brain. RESULTS: Permeability parameters showed no statistical significance between cold and warm saline infusion groups after 3-hour reperfusion 0.09 ± 0.01 min-1 vs. 0.07 ± 0.02 min-1, p = 0.661 for K(trans); 0.30 ± 0.05 min-1 vs. 0.37 ± 0.11 min-1, p = 0.394 for kep, respectively. Behavioral testing revealed no significant difference among the three groups. However, the percentage of MPO-positive cells in the cold-saline group was significantly lower than those in the control and warm-saline groups (p < 0.05). CONCLUSION: Localized brain cooling (20℃) does not confer a benefit to inhibit the increase in BBB permeability that follows transient cerebral ischemia and reperfusion in an animal model, as compared with localized warm-saline (37℃) infusion group.

Analysis of Death due to Poisoning in Gwangju and Jeollanam-do Areas / 대한법의학회지

This study examined 190 cases of confirmed poisoning, as determined by autopsy findings, as well as alcohol and toxicant concentrations in post-mortem specimens. Judicial autopsies were performed from January 2007 to December 2014 at Department of Legal Medicine, Chonnam National University Medical School, the National Forensic Service Gwangju Institute, and St. Carollo Hospital. We analyzed the incidence of poisoning according to region and season in terms of year, sex, age, and classification of toxicants. In the regional classification, the number of deaths due to poisoning in Jeollanam-do and Gwangju areas was similar when considering autopsy numbers. The incidence was higher in autumn and spring than in summer and winter, and a large number of deaths occurred in 2008 and 2014. Additionally, the number of male deaths was approximately twice the number of female deaths, with the age of 50-59 being the most common age group. Pesticides comprised the largest number of deaths due to poison, followed by alcoholism, carbon monoxide, treatment drugs, and cyanic acid, in that order.

Triiodothyronine Levels Are Independently Associated with Metabolic Syndrome in Euthyroid Middle-Aged Subjects

BACKGROUND: Recent studies have shown an association between thyroid hormone levels and metabolic syndrome (MetS) among euthyroid individuals; however, there have been some inconsistencies between studies. Here, we evaluated the relationship between thyroid hormone levels and MetS in euthyroid middle-aged subjects in a large cohort. METHODS: A retrospective analysis of 13,496 euthyroid middle-aged subjects who participated in comprehensive health examinations was performed. Subjects were grouped according to thyroid stimulating hormone, total triiodothyronine (T3), total thyroxine (T4), and T3-to-T4 ratio quartile categories. We estimated the odds ratios (ORs) for MetS according to thyroid hormone quartiles using logistic regression models, adjusted for potential confounders. RESULTS: Of the study patients, 12% (n=1,664) had MetS. A higher T3 level and T3-to-T4 ratio were associated with unfavourable metabolic profiles, such as higher body mass index, systolic and diastolic blood pressure, triglycerides, fasting glucose and glycated hemoglobin, and lower high density lipoprotein cholesterol levels. The proportion of participants with MetS increased across the T3 quartile categories (P for trend <0.001) and the T3-to-T4 ratio quartile categories (P for trend <0.001). The multi-variate-adjusted OR (95% confidence interval) for MetS in the highest T3 quartile group was 1.249 (1.020 to 1.529) compared to the lowest T3 quartile group, and that in the highest T3-to-T4 ratio quartile group was 1.458 (1.141 to 1.863) compared to the lowest T3-to-T4 ratio quartile group, even after adjustment for potential confounders. CONCLUSION: Serum T3 levels and T3-to-T4 ratio are independently associated with MetS in euthyroid middle-aged subjects. Longitudinal studies are needed to define this association and its potential health implications.